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Spirituality, Loss and Grieving

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1Spirituality, Loss and GrievingNurse Caring Concepts 1AWeek 16, December 1, 2003Definitions• Religion: organized system of beliefs concerningcause, nature & purpose of universe, especiallybelief in worship of God.• Spirituality: quality or essence that strives to findmeaning and purpose, even for those who do notbelieve in any god. Strives to be in harmony withthe universe; comes into focus when one facesemotional stress, illness or deathThe 5 Top Reasons Why RNsFail to Provide Spiritual Care• View religious & spiritual needs as private matter• Uncomfortable about own religious beliefs• Lack knowledge about spirituality & religiousbeliefs of others• Mistake spiritual needs for psychosocial needs• View spiritual needs of patient as family or pastoralresponsibility2Spiritual Nursing Care• Goal: assist patients to discover own God or truththat gives meaning to their lives in relation tohealthcare crisis that has created need for nursingcare• Spiritual interventions are as appropriate asphysiologic, psychosocial or teaching interventions• Holistic nursing care mandates that we addressspirituality, just as we address other very personalareas of patients’ livesObjectively Assessing Spiritual Needs• Religious objects• Special clothing• Church bulletins,religious readingmaterial• Prayer• Special diet requests• Mentions God, Allah,Buddha, etc.• Requests clergy• Expresses doubt, fear& anxiety regardingspirituality• Response to visitors• Visits from clergySubjectively Assessing Spiritual Needs• Religious preference• Interest in chapel/clergy• Concept and importance of God• Source of hope and strength• Religious practices and rituals• Relationship between spiritual beliefs/ health3NANDA: Spiritual Distress• Definition: experiences a disturbance in beliefor value system that provides strength, hope &meaning to life.• Major Defining Characteristic: individualexperiences disturbance in belief system• Related Factors: challenged belief system;separation from spiritual ties, conflict betweenbeliefs & prescribed treatment, divorce, deathor illness, barrier to practicing spiritual ritualsGoals• STG: Patient will, by the end of discussion:– Express one feeling related to the changein his spiritual beliefs since becoming ill– Describe one religious/spiritual practicethat he would like to perform• LTG: Patient will express satisfaction withspiritual belief systemImplementation• Use self therapeutically• Communicate about spiritualneeds• Accompany patient• Promote therapeuticenvironment• Provide access to spiritualadvisors• Support faith practicesAssess for & eliminate or reduce factors contributingto spiritual distress:4Definitions• Loss: parting with object, person, belief orrelationship that one values• Bereavement: State of desolation occurring as aresult of loss, particularly death of significant other• Grief: pattern of physiologic and psychologicalresponses to loss• Mourning: conventional behaviors displayed afterthe death of significant other• Anticipatory grief: pattern of physiologic andpsychological responses made to impending lossNormal Grieving Patterns• Grief work: Grieving person’s efforts to deal withphysical and psychological pain associated withbereavement.• Elizabeth Kubler-Ross’ Model: Five stagesassociated with facing one’s own death (denial,anger, bargaining, depression, acceptance)• Parkes’ Model: Four stages of grief associated withbereavement (numbness, yearning, disorganization,reorganization)Dysfunctional Grieving• Falls outside of normal response range, griefmay be exaggerated, prolonged or absent• Patient “stuck” in one stage of grief process• Person spends so much energy repressing ordealing with grief that has little left over fornormal functioning5Factors Affecting Grief Response•Age• Gender• Nature• Timing• Support systems• Relationship withdeceased• Coping mechanisms• Previous grief experiences• Physical conditionCultural Considerations• Mourning is cultural behavior• RNs health-focused & may ignore death & dying• Nurses often with pt & family through stages ofdying and death• Knowing religious & cultural heritage of a pt mayhelp nurse to meet pt’s needs.• All individuals want to die with dignity• Ask and then listen to what the family wants.Grief Assessment• Shock, denial, numbness, confusion• Hysteria, crying, anger, rage, stoicism, calmness• Helplessness, despair, hopelessness, apathy• Hypo or hyperactivity• Self-care neglect (nutrition, hygiene, rest)• Social withdrawal, absent-mindedness• Substance abuse: smoking, ETOH, drugs• Mummification• Panic attack symptoms6Dysfunctional Grieving Risk Factors• Uncertain, sudden, or complicated circumstancessurrounding loss• History of depression, low self-esteem, guilt orprevious complicated grief reactions• Socially unspeakable, negated or disenfranchisedlosses• History of current or past substance abuse• Decrease or loss of social support systems• Cumulative grief over multiple unresolved lossesNANDA: Dysfunctional Grieving• Definition: experiences prolonged, unresolvedgrief & engages in detrimental activities• Defining characteristics: unsuccessful adaptationto loss, delayed emotional reaction, prolongeddenial & depression, inability to resume normalpatterns• Related factors: loss of person, independencefunction, possession, job, status, home, body partsImplementation• Assess for causative and contributing factors todysfunctional grieving• Promote a trust relationship• Support the person and the family’s griefreactions• Promote grief work with each response• Provide health teaching and referral7Goals• STG: Patient will, by the end of my shift:– Acknowledge that she has experienced a loss– Describe two feelings expected with loss– Verbalize intent to seek professional help– Verbalize intent to contact hospice– Verbalize intent to contact a grief support group• LTG: Client will contact professional helpCaring for a Terminally Ill Client• Goal of treatment shifts from curative to palliative(comfort care)• Caring for two clients, the dying person & family• Interventions:– Comfort measures– Pain control– Dehydration management– Therapeutic communicationNursing Care of the Deceased• Dignity for deceased & sensitivity to family• Remove all unneeded medical equipment &supplies; clean, position &


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